Typhoid fever

Typhoid fever

Description, Causes, and Risk Factor

Alternative Names: Enteric fever, typhoid.

An acute infectious disease caused by Salmonella typhi (S. typhi) and characterized by a continued fever rising in a step-like curve the first week, severe physical and mental depression, an eruption of rose-colored spots on the chest and abdomen, tympanites, early constipation, diarrhea, and sometimes intestinal hemorrhage or perforation of the bowel.

Anyone can get typhoid fever if they drink water or eat food contaminated with the S. typhi bacteria. Travelers visiting developing countries are at greatest risk for getting typhoid fever. Typhoid fever is still common in the developing world, where it affects about 12.5 million persons each year. Only about 400 cases occur each year in the United States.

The incubation period depends on the size of the infecting dose; from 3 days to 3 months with a usual range of 1-3 weeks. For Paratyphoid fever, it is as low as one to 10 days.

Agent: Salmonella enterica serotype Typhi, serotype Paratyphi A, Paratyphi B, and Paratyphi C. The bacteria spread from the intestine via the bloodstream to the intestinal lymph nodes, liver, and spleen via the blood where they multiply.

  • Host: In endemic areas, typhoid fever is most common in preschool and school-aged children (5-19 years of age).
  • Reservoir: Only humans for both typhoid and paratyphoid. Especially gall bladder carriers and rarely urinary carriers.

Salmonella typhi bacteria live in the intestines of infected persons and are found in the feces and urine of a person who is ill or who is a carrier of the bacteria (a carrier has no symptoms of illness but continues to shed bacteria). The bacteria may be found in food, water, or surfaces that have been contaminated with infected feces. The disease is spread by eating food contaminated with the bacteria or by putting a contaminated object in one's mouth. For example, water can be contaminated with sewage. Food and surfaces can be contaminated by contact with infected feces from a person's hands.

Most cases of typhoid fever are associated with poor sanitary conditions or poor personal hygiene. The disease is also spread when someone handles objects which were used by an infected person who did not carefully wash his or her hands after using the toilet or changing a diaper.

Symptoms

If you have typhoid fever you may have the following symptoms:

Constant fever up to 104°.

  • Malaise.
  • Chills.
  • Confusion.
  • Diarrhea.
  • Non-productive cough.
  • Constipation.
  • Bradycardia (slow heart rate).
  • Stomach pain.
  • Anorexia.
  • Headache.
  • Body ache.
  • A rash, characteristic only of typhoid and called "rose spots," appears in some cases of typhoid. Rose spots are small (1/4 inch) red spots that appear most often on the abdomen and chest.

Diagnosis

Typhoid fever is diagnosed by isolation of S. Typhi from blood, stool, urine or other clinical specimens including bone marrow.

Serologic tests such as the Widal test are of low sensitivity and specificity and generally provide little diagnostic value. Antibody titer of the Widal test rises during the infection, and early positive blood and urine cultures become negative, usually results in immunity.

Signs:

An elevated white blood cell counts in blood.

  • A blood culture during a first week of the fever can show S. typhi bacteria.
  • An ELISA test on urine may show Vi antigen specific for the bacteria.
  • Decrease platelet count.
  • A fluorescent antibody study demonstrates Vi antigen, which is specific for typhoid.

Treatment

Typhoid fever is treated with antibiotics. A person will usually recover in 2-3 days with prompt antibiotic treatment. People that do not get prompt medical treatment may continue to have a fever for weeks or months and as many as 20% may die from complications of the infection.

If you are being treated for typhoid fever, it is important to do the following:

Take the prescribed antibiotics for as long as the doctor has asked you to take them.

  • Wash your hands carefully with soap and water after using the bathroom.
  • Do not prepare or serve food to other people.
  • Have your doctor collect follow-up stool samples to ensure that no S. typhi bacteria remain in your body.

Preventive Measures:

Get vaccinated against typhoid fever. Both injectable and oral vaccines are available.

  • Only use clean and boiled water.
  • Only eat foods that have been thoroughly cooked.
  • Avoid raw vegetables and fruits that cannot be peeled.

Disclaimer: The above information is an educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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